Provider Demographics
NPI:1033485099
Name:SUNSHINE ASSISTED LIVING HOME II
Entity type:Organization
Organization Name:SUNSHINE ASSISTED LIVING HOME II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERDIE
Authorized Official - Middle Name:TAN
Authorized Official - Last Name:ODRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-947-6262
Mailing Address - Street 1:8037 COUNTRY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-4691
Mailing Address - Country:US
Mailing Address - Phone:907-947-6262
Mailing Address - Fax:907-522-5322
Practice Address - Street 1:6261 COLLINS WAY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-2147
Practice Address - Country:US
Practice Address - Phone:907-868-1229
Practice Address - Fax:907-522-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100937310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility